臺灣博碩士論文加值系統

糖尿病的管理需要飲食、運動及藥物三方面互相配合，達到良好的血糖控制，以避免或延緩併發症發生。其中飲食管理包括份數控制、食物選擇及外食等飲食行為的改變，但目前探討糖尿病患的飲食習慣的研究甚少。本研究目的在探討第2型糖尿病患者的病況與哪些飲食內容及習慣的相關性。研究對象為五甲某地區醫院內科門診101位參加糖尿病試辦計畫之第2型糖尿病患者，飲食評估以飲食問卷及24小時飲食回憶進行調查。結果顯示糖化血色素(HbA1c)與糖尿病病程、降糖藥物種類、外食習慣總分及睡眠時間呈顯著正相關(r值分別為0.244、0.341、0.364、及0.219)，特別是午餐外食及晚點外食頻率均與HbA1c顯著呈正相關(r值分別為0.229與0.212)。HbA1c也與餐次定時頻率呈顯著負相關(r=-0.202)，特別是午餐定時影響最大(r=-0.212)。HbA1c與飲食中的維生素A攝取量呈負相關(r=-0.200)。睡眠時間與維生素A攝取量呈負相關(r=-0.209)，也與HbA1C、禁食血糖、飯後血糖顯著呈正相關(r值分別為0.233、0.338、0.219)。運動時間與BMI、外食習慣總分顯著呈負相關(r值分別為0.411、0.338)。運動時間與定時習慣總分、定量習慣總分顯著呈正相關(r值分別為0.411、0.338)。有遵醫囑者在定時、定量的習慣總分比沒遵醫囑者好，且外食習慣總分較少(p值分別為0.050、0.057、0.002)，睡眠時間也較短(平均8.34 ±1.33 vs 9.07±1.71小時; p=0.037)。綜合上述結果，第2型糖尿病患者對病情的控制除了藥物治療外，減少外食頻率有助於血糖控制。另外，增加維生素A攝取量可能有助於血糖控制，但仍需再進一步研究確認其相關性。

There are three factors for management of diabetes mellitus, including diet, exercise and drugs, which complementally optimize glycemic control to avoid or delay the further complications. The dietary factor for management of diabetes includes protions control, food choices and changes in eating behaviors, such as decrease of the frequency of dinging out. Little is known about the association of type 2 diabetes (T2D) between dietary habits. The aim of this study was to find the relationship of glycemic control between dietary contents or dietary habits in T2D patients. The 101 subjects who are outpatients with T2D from a hospital at Kaohsiung Wujia, participated in the government project “Pay-for-Performance Program for Diabetes Care”, and their lifestyle, dietary habit and nutrition intake assessed by questionnaires and 24-hour dietary recall interview. The results significantly showed that hemoglobin A1c (HbA1c) are positively correlated with the duration of diabetes, kinds of hypoglycemic drug, frequency of dinging out and duration of sleep (r=0.244, 0.341, 0.364, and 0.219, respectively), especially the dinging out frequency of lunch and night snack were positively correlated with HbA1c(r=0.229 and 0.212, respectively). HbA1c is also significantly and negatively correlated with the frequency of regular meal times(r=-0.202), especially negatively correlated with the frequency of regular habit of lunch (r=-0.212). HbA1c is significantly and negatively correlated with dietary vitamin A intake (r=-0.200). The sleep duration is significantly and negatively correlated with vitamin A intake (r=-0.209), but is significantly and positively correlated with HbA1c, fasting glucose, and postprandial glucose (r=0.233, 0.338, and 0.219, respectively). The duration of exercise is significantly and negatively correlated with BMI and total score of dinging out habit (r=-0.198 and -0.241, respectively).The duration of exercise is significantly and positively correlated with the total score of regular dietary habits and the total score of quantitative dietary habits (r=0.411 and 0.338, respectively). As compared with the non-compliant patients, the compliant patients are with higher total score of quantitative dietary habit and regular dietary habits, with lower total score of dinging out habit (p=0.050, 0.057, and 0.002, respectively), and with shorter sleep duration (average 8.34 ± 1.33 vs 9.07 ± 1.71 h; p =0.037). In addition to drug therapy, the glycemia of T2D patients could be improved by reduction in the frequency of dinging out, keeping in regular meal habit, and increase in intake of vitamin A. It is needed further research to confirm the effect of vitamin A on blood glucose.

目 錄
誌謝 ----------------------------------------------------------i
中文摘要 ----------------------------------------------------------ii
英文摘要 ----------------------------------------------------------iii
目錄 ----------------------------------------------------------v
表目錄 ----------------------------------------------------------vi
圖目錄 ----------------------------------------------------------vii
第一章 緒論-------------------------------------------------------1
第二章 文獻探討----------------------------------------------------3
第一節 糖尿病之流行病學---------------------------------------------3
第二節 糖尿病簡述--------------------------------------------------4
第三節 糖尿病管理--------------------------------------------------14
第三章 材料與方法--------------------------------------------------20
第一節 研究架構----------------------------------------------------20
第二節 研究設計----------------------------------------------------21
第三節 研究對象----------------------------------------------------21
第四節 研究工具----------------------------------------------------22
第五節 名詞定義----------------------------------------------------25
第六節 研究流程----------------------------------------------------27
第七節 研究倫理與權益維護--------------------------------------------28
第八節 統計分析----------------------------------------------------29
第四章 結果與討論---------------------------------------------------30
第一節 人口學特性資料分析--------------------------------------------30
第二節 血液生化値特性分析--------------------------------------------34
第三節 營養素攝取量特性分析------------------------------------------36
第四節 飲食餐次習慣特性分析------------------------------------------42
第五節 生活習慣與糖尿病控制相關因子之分析------------------------------54
第六節 HbA1c與相關因子之分析-----------------------------------------59
第五章 結論--------------------------------------------------------62
參考文獻 -----------------------------------------------------------64
附錄一 問卷內容專家效度名稱------------------------------------------77
附錄二 糖尿病病人收案資料表------------------------------------------78
附錄三 人體試驗委員會核准函------------------------------------------81
附錄四 受訪同意書---------------------------------------------------82
表 目 錄
表1 第2型糖尿病之治療目標-----------------------------------------13
表2 受試者基本資料特性與男女的基本資料之差異比較----------------------31
表3 年長與年輕受試者在基本資料之差異性分析---------------------------32
表4 受試者HbA1c與基本資料之相關性分析------------------------------33
表5 受試者血液生化値特性與男女的血液生化値之差異比較------------------34
表6 年長與年輕受試者在血液生化值之差異性分析-------------------------35
表7 受試者每日營養素攝取量特性與男女的營養素攝取量之差異比較------------37
表8 年長與年輕的在營養素攝取量之差異性分析---------------------------38
表9 受試者HbA1c與營養素攝取量之相關性分析---------------------------41
表10 受試者進食餐次頻率特性----------------------------------------43
表11 受試者餐次頻率與體位及血液生化值之相關性分析---------------------43
表12 受試者定時定量頻率特性----------------------------------------44
表13 受試者定時頻率與體位及血液生化值之相關性分析---------------------45
表14 受試者定量頻率與體位及血液生化值之相關性分析---------------------46
表15 受試者外食/外帶頻率特性---------------------------------------47
表16 受試者外食頻率與體位及血液生化值之相關性分析---------------------48
表17 受試者飲食習慣總分與體位及血液生化值之相關性分析------------------49
表18 受試者外食習慣總分與營養素攝取量之相關性分析---------------------51
表19 飲食習慣總分與基本資料之相關性分析------------------------------52
表20 受試者年齡與飲食習慣之相關性分析(n=101) ------------------------53
表21 運動時間與其他糖尿病控制相關因子之相關性分析---------------------55
表22 睡眠時間與其他糖尿病控制相關因子之相關性分析---------------------56
表23 睡眠時間與各餐次飲食頻率習慣之相關性分析-------------------------57
表24 是否遵醫囑與其他糖尿病控制相關因子之差異性分析--------------------58
表25-1 HbA1c與相關因子之多元迴歸分析(Model 1)-------------------------60
表25-2 HbA1c與相關因子之多元迴歸分析(Model 2)-------------------------60
表25-3 HbA1c與相關因子之多元迴歸分析(Model 3)-------------------------60
表25-4 HbA1c與相關因子之多元迴歸分析(Model 4)-------------------------61
表25-5 HbA1c與相關因子之多元迴歸分析(Model 5)-------------------------61
圖 目 錄
圖1 第2型糖尿病臨床藥物治療指引建議--------------------------------15
圖2 研究架構圖--------------------------------------------------20
圖3 研究流程----------------------------------------------------27
圖4 HbA1c與外食頻率總分之pearson相關------------------------------50

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